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尼可地尔与曲美他嗪对经皮冠状动脉介入术后患者血管内皮功能及炎性因子的影响

Effects of nicorandil or trimetazidine on endothelial function and inflammatory factors in patients with coronary heart disease after PCI

摘要:

目的 比较尼可地尔与曲美他嗪对冠心病患者经皮冠状动脉介入(PCI)术后血管内皮功能及炎性因子的影响.方法 160例行择期PCI治疗的冠心病患者,采用随机数字表法将其分为四组,每组40例.尼可地尔组于PCI术前72 h开始口服尼可地尔片5 mg/次,3次/d;曲美他嗪组于术前72 h开始口服盐酸曲美他嗪片20 mg次,3次/d;联合用药组于术前72 h开始口服上述同等剂量的尼可地尔和曲美他嗪;对照组不给予尼可地尔或曲美他嗪治疗.观察各组PCI术前、术后6 h、术后12 h、术后24 h肌酸激酶同工酶(CK-MB)和肌钙蛋白(cTnI)的动态变化,并比较各组PCI术前、术后6 h、术后24 h内皮素(ET-1)、一氧化氮(NO)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)及白介素6(IL-6)的差异.结果 对照组术后CK-MB、cTnI较术前明显升高(t=2.500、3.663、4.168、5.783、4.912,均P<0.05),其余三组术后未见明显变化(P>0.05).尼可地尔组、曲美他嗪组、联合用药组术后cTnI均明显低于对照组(F=11.960、15.643、16.078,均P<0.05),但三组间差异无统计学意义(P>0.05).四组患者术后ET-1、hs-CRP、TNF-α、IL-6均较术前明显升高(对照组:t=6.897、5.293、15.934、16.759、8.516、9.209、6.809、6.757,均P<0.05;尼可地尔组:t=2.254、8.903、11.280、5.961、5.992、4.235、4.738,均P<0.05;曲美他嗪组:t=3.425、10.513、11.582、4.117、5.696、4.130、3.868,均P<0.05;联合用药组:t=3.180、9.204、10.107、4.839、6.214、5.151、5.883,均P<0.05),NO较术前明显降低(对照组:t=5.707、5.066,均P<0.05;尼可地尔组:t=2.701、2.393,均P<0.05;曲美他嗪组:t=3.662、3.163,均P<0.05;联合用药组:t=2.632、2.427,均P<0.05),尼可地尔组、曲美他嗪组、联合用药组术后ET-1、hs-CRP、TNF-α、IL-6均明显低于对照组(F=9.709、7.794、43.772、47.321、15.252、10.565、5.632、4.372,均P<0.05),NO明显高于对照组(F=14.138、8.374,均P<0.05);尼可地尔组术后NO高于曲美他嗪组(t=2.249、2.305,均P<0.05),其余指标三组间差异无统计学意义(P>0.05).析因分析显示,尼可地尔与曲美他嗪在改善ET-1、NO、hs-CRP、TNF-α、IL-6等方面无交互作用(P>0.05).结论 尼可地尔与曲美他嗪均有助于减轻PCI相关心肌损伤,改善PCI术后内皮功能,抑制炎性因子释放,但两者无协同作用;尼可地尔在改善血管内皮功能方面可能更有效.

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abstracts:

Objective To compare the effects of nicorandil and trimetazidine on endothelial function and inflammatory cytokines in patients with coronary heart disease after percutaneous coronary intervention (PCI),and to analyze the synergistic effect .Methods 160 patients with coronary heart disease underwent elective PCI were enrolled and randomly divided into four groups ,40cases in each group .The nicorandil group was given nicorandil tab-lets 5mg once time,3 times a day at 72h before PCI.The trimeshamazine group was given trimetazidine tablets 20mg once time,3 times a day.The combined group was given the same dose of nicorandil and trimetazidine .The control group was not given nicorandil or trimetazidine .The changes of CK -MB,cTnI,ET-1,NO,hs-CRP,TNF-αand IL-6 were observed and compared before and after PCI .Results The CK-MB and cTnI in the control group were significantly increased after PCI (t=2.500,3.663,all P<0.05;t=4.168,5.783,4.912,all P<0.05),but there were no statistically significant differences in the other three groups (all P>0.05).The level of cTnI in the control group was higher than that in the other three groups after PCI (F=11.960,15.643,16.078,all P<0.05).After PCI,the levels of ET-1,hs-CRP,TNF-αand IL-6 in the four groups were all significantly increased ( control group:t=6.897,5.293,all P<0.05;t=15.934,16.759,all P<0.05;t=8.516,9.209,all P<0.05;t=6.809, 6.757,all P<0.05;nicorandil group:t=2.254,P<0.05;t=8.903,11.280,all P<0.05;t=5.961,5.992,all P<0.05;t=4.235,4.738,all P<0.05;trimetazidine group:t=3.425,P<0.05;t=10.513,11.582,all P<0.05;t=4.117,5.696,all P<0.05;t =4.130,3.868,all P<0.05;combination group:t =3.180,P<0.05;t =9.204, 10.107,all P<0.05;t=4.839,6.214,all P<0.05;t=5.151,5.883,all P<0.05),and NO level was significantly decreased(control group:t=5.707,5.066,all P<0.05;nicorandil group:t=2.701,2.393,all P<0.05;trimetazi-dine group:t=3.662,3.163,all P<0.05;combination group:t=2.632,2.427,all P<0.05).The levels of ET-1, hs-CRP,TNF-αand IL-6 in the control group were significantly higher than those in the other three groups after PCI(F=9.709,7.794,P<0.05;F=43.772,47.321,P<0.05;F=15.252,10.565,P<0.05;F=5.632,4.372, P<0.05),and NO level in the control group was lower than that in the other three groups (F=14.138,8.374,all P<0.05).The level of NO in the nicorandil group was higher than that in the trimetazidine group (t=2.249,2.305, all P<0.05).There was no synergistic effect between nicorandil and trimetazidine in improving ET -1,NO,hs-CRP,TNF-αor IL-6(P>0.05).Conclusion Both nicorandil and trimetazidine may help to relieve PCI -related myocardial injury , improve endothelial function , inhibit inflammatory factors after PCI , but there is no synergistic effect.Nicorandil may be more effective in improving endothelial function .

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